Customizable Pressure Offloading Cushioning Device

ABSTRACT

The subject invention is a device intended for use where support or restriction of motion of a body part is desired. The subject of the present invention is the formation of a network of lattice intrusions into the matrix of the device so that elements of the lattice can be removed to form a depression in the matrix of the device that conforms to the anatomy of the region that is being supported and positioned while offloading pressure.

BACKGROUND

The nervous system of humans and higher animals is uniquely developed toperceive sensations that present a risk of harm to the being. One ofthose threats is prolonged pressure at a point of contact. Prolongedpressure or point pressure loading on the tissues is uncomfortable andmay be painful. The transmission of a signal of discomfort or pain tothe brain stimulates a counter signal from the brain to the skeletalmuscles calling for some movement. This movement is intended toalleviate the pressure.

Prolonged point loading is deleterious and can lead to significanttissue damage and, in some cases, life-threatening injuries. Gravityplaces forces on the body to generate the sensation of mass. The body isprevented from sinking to the center of Earth by whatever structure itmight be resting on. This is easy to relate to when one considers that,when standing, there is considerable pressure on the soles of the feetbut almost none on the palms of the hand. Bony protrusions such as thepoint of the elbow, back of the head, hips, and knees are just someexamples of places that typically end up being prominent contact pointscounteracting the force of gravity depending upon the position of thebody. If the nervous system does not sense, or the body is unable torespond to the signals of prolonged pressure, an adverse situation canarise.

Prolonged pressure has a profound affect on the soft tissues. When bloodvessels, muscle, subcutaneous fat, and skin are compressed between boneand an external surface it compromises the normal functions of thatarea. These opposing forces result in a cone-shaped pressure gradient(Pressure Ulcers-Guidelines for Prevention and Nursing Management,Second Edition). All of the tissue between the external surface and theskeletal anatomy is involved. However, the greatest tissue destructionis beneath the skin surface at the bony interface. If left undisturbedthis decreased circulation to the area can drive the oxygen tension ofthe region into a state of hypoxia and eventually necrosis. The necroticarea can then rupture into a wound that begins inside the body anderodes to the outside. These are often referred to as “pressureinjuries” (NPUAP, National Pressure Ulcer Advisory Panel).

Pressure injuries/ulcers are difficult to detect until they haveeventually erupted to the outside skin. By that time there isconsiderable tissue damage that creates an ideal location for theestablishment of an infection and, if left untreated, may become lifethreatening to the individual.

Normal healthy individuals are seldom afflicted with pressureinjuries/ulcers because the sensation of point loading is a strongdriver to change positions to offload the weight on the affectedtissues. Medically compromised individuals are much more susceptible tothe development of pressure injuries/ulcers. In many cases medicallycompromised individuals may lack the energy or strength to changepositions. In other cases, they simply may not perceive the pressure onthe affected tissues and thereby not have any urge to change positions.These are reasons why a main feature of skilled nursing of medicallycompromised individuals involves protection against the development ofpressure injuries/ulcers. This medical condition is so prominent anddangerous to the health of compromised patients that there is aguideline for care givers for pressure injury/ulcer prevention (PressureUlcers-Guidelines for Prevention and Nursing Management, SecondEdition).

Protecting patients from the development of pressure injuries/ulcers dueto prolonged unrelieved pressure involves monitoring pressure points andmaking sure that persistent pressure contact does not occur. In somecases, this may be done by turning the patient to reposition body weighton a regular time schedule to allow for capillary refill time for goodskin integrity. For example, the bony prominence of the hip may be apoint where a pressure injury/ulcer may develop. By turning the patientfrom one side to the other on a regular basis can be successfully usedto prevent tissue hypoxia from occurring. Scheduled repositioning is anormal program used in many long term care, and acute care facilities toprevent pressure injury/ulcer formation.

Studies indicate that comprehensive prevention programs are effective inreducing incidence rates and can be cost effective (Courtney H. Lyder,ND-Pressure Ulcer Prevention and Management). Thus, prevention iscritical to reduce overall health costs (AHRQ, Agency for HealthcareResearch and Quality-Preventing Pressure Ulcers in Hospitals, A Toolkitfor Improving Quality of Care). In the U.S. 2.5 million patients developpressure ulcers each year. Pressure ulcers cost $9.1-$11.6 billion peryear to the US health care system. The cost of individual patient careranges from $20,900 to $151,700 per pressure ulcer. Medicare estimatedin 2007 that each pressure ulcer added $43,180 in costs to a hospitalstay. More than 17,000 lawsuits are related to pressure ulcers annually.It is the second most common claim after wrongful death and greater thanfalls or emotional distress (Goebel et al, Clinical Practice Guidelinesfor pressure ulcer prevention can prevent lawsuits in older patients.JWOCN). In a study of the impact of compliance on medical malpracticeawards: 35 Plaintiffs were awarded $14,418,770. Had health caredefendants followed guidelines $11,389,989 might have been saved in 20lawsuits in addition to the plaintiffs' pain and suffering fromresulting pressure injuries/ulcers.

Turning a patient or offloading a pressure point is simplistic inconcept but can be problematic in making sure that the patient remainsin the desired position. Nursing care often use pillows or blanketsrolled in such a way to “pack” in around the patient to assist inmaintaining the desired position. Whilst these approaches have someutility they are not always useful for offloading the weight. In fact,in some cases pillows and blankets packed too tightly lead to the verycomplication that they were intended to alleviate. To better serve thepatients needs and to facilitate offloading of pressure more uniformly,products such as the Global Medical Foam, Inc. (Langer, U.S. Pat. No.6,360,388) positioning devices have been developed. These devices arecushioning for the body region and have unique designs that ensures amore even distribution of weight over the device. The devices areconstructed of polyurethane foam with a solid foam core for rigiditysurrounded by a softer foam layer uniquely cut so that it projects foamfingers outwardly from the core. The fingers compress and bend in such away that the pressure loading is very evenly distributed over a muchlarger area of the body and the core center is intended to support thebody weight. Moreover, because of the unique finger projects they can bewedged in place to very adequately and comfortably support patients inan offload position and in some cases can decrease the frequency forskilled nursing to assist in repositioning.

A wide variety of medical devices have been developed for pressurereduction/pressure redistribution. One such device by Mead et al (PCT/US2008/074812) is a bladder that contains a combination of elastomericfoam and a light weight fluid wherein the fluid freely moves within thebladder to accommodate weight distribution and the foam prevents“bottoming out” of a part of the anatomy when it is used. In anotherproduct marketed by Sunrise Medical (Christofferson, et al, U.S. Pat.No. 7,146,666), the bladder is specially constructed to have internalbaffles that allow air, as the support medium, to move somewhat freelythrough the device when it is used to cushion the patient. This devicehas advantages of being very lightweight and cushioning but does havesome limitations in the true distribution of weight evenly over thedevice. In another invention, a wheelchair cushion with an anatomicalsupport includes a patient interface layer of gel, a matrix panel and afoam base (Lampel, et al, U.S. Pat. No. 6,625,830). Although gels thatare free to move aid in distribution of weight they have the limitationof being very poor support media and have a high potential for bottomingout and do not provide the offloading attribute thus potentially causingtissue interface pressure.

There are many examples of devices that have design features andmaterial choices for aiding in the offloading of areas of the anatomy.Synthetic and natural rubberized materials are commonly used for thispurpose primarily because they are generally soft to the touch andnaturally provide some cushioning. Open and closed cell foams such asthose formed of polyurethane are commonly used. Other foams are composedof natural latex or polyvinyl materials. Collectively these areelastomeric foams. All foams can be evaluated and given an RMA Value(Rubber Manufacturers of America) which relates to the cushioning orsoftness of the foam. Ideally the foam of choice is one that isconstructed of sufficient elasticity, flexibility, conformability andetc. so that it distributes weight but does not bottom out when it isused to support the anatomy. In most cases the combination of devicedesign and the cushioning index of the material used in its constructioncombine to provide some utility of design.

Offloading is a medical necessity to prevent pressure injury/ulcerformation. The repositioning of the body is effective for many patients.However, there are some patients where repositioning is not an option.Patients in prolonged traction, patients that are confined to lie ontheir back, side or stomach for some medical reason, or burns patients.Although regular scheduled repositioning may not be an option they arestill susceptible to the formation of ulcers. In other cases, a patientmay already have pressure induced, surgery induced or trauma inducedwounds that need total offloading. In cases such as these it isimperative that support surfaces be such that they significantlyredistribute the weight of the patient over a much broader tissuesurface area. In addition, it may be necessary that the weight betotally offloaded from some portion of the anatomy. Special devices suchas air bed mattresses are an example of devices that attempt tosignificantly redistribute weight but they may not totally offloadweight from specific regions of the anatomy. In addition, these may beeffective for the entire body, but they may not either be available, aretoo expensive, or they may be ineffective when only a portion of theanatomy needs offloading. Furthermore, many support devices come as onesize fits all which is entirely unpractical in many cases. There is aneed for devices that can be customized to offload and redistribute bodyweight pressure effectively particularly areas of specific anatomy. Sucha customized device might be one that could be modified at bedside tofit a region of an arm, a leg, a backside or the head taking intoaccount that arms, legs, feet, heads, and etc. vary in size and shapeamong the multitude of patients that may need such assistance. Such adevice would be a customizable device in the sense that material couldbe selectively removed from the device so as to shape it to conform veryspecifically to the anatomy in need of support. Such a devicefurthermore could be conformable to totally offload the weight thatmight cause damage to specific anatomical sites. Such a device would beconsiderably different from existing art in the sense that thecustomizable features would enable the care giver to modify the devicefor the patient's specific needs. The invention described herein is acustomizable device that is able to be very simply modified to conformin shape and utility to aid in the management of a patient's anatomy forthe aim of providing comfort, and offloading to prevent the formation ofpressure injuries/ulcers.

Several inventors have proposed improvements in support devices that areintended to better prevent pressure injuries from occurring. In one suchimprovement, Christofferson (Christofferson et al, U.S. Pat. No.7,146,666) described a bladder which contained a fluid medium that wasfree to move within the bladder to conform to the contours of theanatomy. Such a device achieves very good contour to form conformationto the anatomy but it is not a good system for weight distribution andcan not totally offload weight from a wound site if that is required.

Raburn et al (Raburn et al, U.S. Pat. No. 5,459,896) described a way ofimproving the cushioning support provided by polyurethane foam bydescribing the formation of a grid like pattern of channels into theanatomy-contact side of a foam device wherein the cuts specificallyremoved a portion of foam so that the grid projections of foam weretotally independent and not touching adjacent projections. This reliefof foam allowed the grid portions of foam to move independently but didnot provide any ability to totally offload an area if needed nor did itprovide any contour fitting of the device to conform to the anatomicalshape of the supported anatomy.

Farley (Farley et al, U.S. Pat. No. 5,038,433) was substantially similarto the Raburn invention but provides more relief at the bottom of thechannels so that moisture vapor and air more freely moves through thechannels of the device. This is said to decrease the accumulation ofbody perspiration in the device.

All of these inventions substantially improved the weight distributionproblem that is so necessary for the management of persons confined toprolonged sitting or reclined positioning. However, these devicesaddress either pressure redistribution or contouring of the device butnone of them address the totality of the needs for managing anatomicalpositioning, pressure re-distribution and total offloading for patientswith restricted mobility. There has been a need for a device thatprovides weight re-distribution, positioning of the anatomy and apotential for total offloading of an anatomical area. Since all of theseneeds are prescribed by a medical needs of the individual patient, andoften one with limited mobility, the ideal device would incorporate allof these requirements into a single device. In addition, due to thedifferences of the anatomical features that make individuals distinctivefrom one another, it makes sense that a composite of these features alsohave some degree of flexibility for “molding” the device to fit theindividual.

The solution to this unmet need is a customizable cushioning supportdevice that, in preparation for use, is able to be modified to moreclosely fit the anatomical surface area contours where positioning,weight redistribution, and offloading are needed to meet the carerequirements of the patient to more comfortably stabilize the positionwhere immobilization and/or support of the anatomy is desired. Such adevice would have utility in clinical application in that it would allowthe patient's care givers to shape the device to more precisely fit tothe contours of the anatomy the device it is intended to contact. Apredominate feature of such an invention would be ease of use, bedsideadaptability to the patient's needs, functionality in positioning andsupport, and affordability. Foams, such as polyurethane and viscoelasticfoams, are widely used in support devices of the nature used forpositioning and weight distribution. However, these foams arehomogeneous materials composed of either closed or open cells withvarying degrees of compressibility due to their density and thickness.These materials have very limited utility in their raw manufacturedform. To provide more useful devices for intended purposes developershave found that modifying the foam buns with cuts, coatings and designssubstantially improve their utility for positioning, weightredistribution or offloading when used in the patient settings. Theinvention herein described is an improvement whereby foams such aspolyurethane or viscoelastic can be milled to form a product thatenables the patient and/or care giver the ability to easily modify itsshape to conform to the anatomical features of the patient to providepositioning, weight redistribution and offloading of specific parts ofthe anatomy to aid in the prevention of pressure inducedinjuries/ulcers.

SUMMARY OF THE INVENTION

The subject of this invention is a foam device such as a polyurethane orviscoelastic foam that has been manufactured in such a way that it iseasily modified at the point of use, such as at the patient bedside, toprovide positioning, weight redistribution and/or partial or totaloffloading of weight from a specific area of a patient's anatomy. Thesalient feature of the invention is the formation of small pillars offoam matrix in the foam bun where said small pillars of the foam matrixthat are formed into the anatomical contact side of the device. Theintention of the pillars of foam projecting from intact base portion ofthe device is to provide a lattice of closely adjoined structures thatcan be selectively decreased in length by the care giver to cause theformation of depression(s) in the matrix that conforms to the contoursto the anatomical region where it will be used on the patient.

Polyurethane foam of a 1-5 pound per cubic foot density is an ideal softmaterial that can be easily formed at manufacturing to accomplish thedesired features of the device. Polyurethane foam or other elastomericfoam provides uniformly soft homogeneous materials that are often usedin mattresses, pillows, support, and positioning devices. Most of thesedevices are machine cut from large buns of foam. These machines useblades, compression points, and wires that are programmed to cut veryprecise shapes and sizes into the off-cuts in forming the finisheddevice. Although foams are soft, pliable and elastic they are not easilycut or trimmed by hand with any degree of precision, particularly in therushed clinical environment. Indeed, precision cutting and shaping ofpolyurethane foam from buns of foam requires sophisticated programmablemachinery that is entirely impractical to house in the clinicalenvironment. Although polyurethane foam is an ideal material that hasbeen used extensively in support devices, its utility as a customizabledevice has traditionally been limited.

The present invention overcomes this limitation by adding manufacturedintrusions or cuts that form a lattice array of pillars of matrix thatsit upon the intact base of the foam during the manufacturing process.Although other manufacturers have introduced products that have gridpatterns cut into the surfaces of their devices, no manufacture hasconsidered the use of resulting protrusions of foam of the grid patternfor the purpose of customizing the device to the contours of the anatomyof the individual patient. Furthermore, the grid patterns in otherinventions are excessively large (Raburn, et al, US 00D3945785) and tooshort to provide utility as a customizable device. The gridmanufacturing of other inventions such as Raburn (Raburn, et al, U.S.Pat. No. 5,459,896) are accomplished by forming significantly widechannels in the matrix on the patient contact side of the matrix of thefoam. These channels are intended for purposes such as ventilation ofperspiration and to prevent shear injury when the patient moves. Sincethese structures are essentially dispersed they lack one of the benefitsof intact foam, namely support. In other words, the structures do notbenefit from the lateral support of adjacent structures. In someapplications this might be beneficial to the patient but where the careneeds prescribe support, weight distribution, offloading and positioningthey are deficient. In the present invention the pillars are cut intothe matrix to between 55% to 90% of the depth of the matrix into theanatomical contact side of the device. The cuts remove little or nomatrix so that there are no channels formed between the pillars thatstand on the intact base of the material. In addition, the latticeformation of pillars is constructed only in the appropriate area of thedevice that will substantially be in contact with the anatomic region ofthe patient. The importance of this feature is that the adjacent pillarsprovide lateral support to one another so that the overall affect is anaction of intact unmodified foam thus providing precise positioning andoffloading while maintaining overall weight redistribution.

In use the narrow pillars of matrix in the lattice array are intended tobe partially or completely removed by simply pinching off the portionthat needs to be removed. This selective action can be used to form avery precise depression in the foam that fits the contours of theanatomical region of the patient. These pillars are sufficiently narrowbut long enough so that they can easily be grasped by the care giver, aprocess that would not be practical with larger protrusions of foam orwith intact foam. By moving from pillar to pillar it is possible then tocreate a contoured depression in the support device that is an exact fitto the anatomical area that is in need of weight redistribution or totaloffloading. This procedure is one of picking the correct pillar forremoval and then plucking out the correct amount of material that needsto be removed to create the customized support device. This “pick andpluck” procedure is repeated until a fully customized device is shapedby the care giver to fit the anatomy of the patient where it is intendedto be used.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 depicts a block of foam that has been cut into an appropriateshape for cervical support form. The upper portion of the device [1]illustrates the anatomy contact side of the device with a lattice array[2] of cuts into the matrix of the homogeneous foam [3] of the device.The independent pillars [4] of matrix formed in the cutting processstand upon the intact base [5] of matrix of the foam device. The overallshape of the device in this depiction is appropriate for supporting thecervical region of the anatomy.

FIG. 2 depicts a block of foam that has been cut into an appropriateshape for cervical support form. [1] The homogeneous foam matrix with anoverall for cervical support. [2] An independent pillar of foam restingon the intact base of the device. [3] The intact base of matrix thatsupports the pillars of foam. [4] A depression in the construct createdby the selective removal of portions or all of selected pillars toconform to an anatomical region of the patient. [5] Lattice array cutinto the foam from the anatomy contact side of the device.

FIG. 3 illustrates the [1] anatomy contact side of the device; and [2]the intact base of the device. [3] Illustrates a cut away of the foammatrix to illustrate the independent pillars of foam supported on theintact base of matrix material [2].

FIG. 4 illustrates the preparation of the device for use wherein [1] isan independent unmodified pillar of matrix sitting upon the intact base[4] of the device. The pillars of foam may be manually shortened as in[2] to form a depression in the matrix [3] appropriate for offloadingand redistributing the weight of the patient's anatomy.

DETAILED DESCRIPTION OF THE DEVICE

All of the devices of the invention are comprised of a cushioningsupport matrix such as a polyurethane foam or other such elastomericfoams. In all cases the foam may be generally cut to a size and overallshape suitable for its intended application. For example, a wheel chaircushion would be cut to a shape and form that is sufficient to fit in awheel chair with sufficient thickness so that it would not be compressedso far that it bottoms out when used by a patient.

Elastomeric foam and in particular polyurethane foam is formed fromstock buns that are then used as the raw material for the manufacturingof cushioning devices of this subject invention. These stock foam bunsare then cut in any suitable manner to form the general dimensions ofthe finished device. Cutting is accomplished by the use of a foamcutting knife or wire fitted in a programmable foam cutting machine.This cutting of the raw shape could be accomplished by other methodsthat might commonly be employed for the cutting of such materials. Ifthe intended use of the device were to be a wheel chair seat then thefoam would be cut to an appropriate size to fit a wheel chair support.Usually such devices are then packages as is or have additional materialadded to them such as coatings or covers to make the finished device. Inthe case of the subject invention additional cuts made substantiallythrough the foam matrix would be applied to the surface that is intendedto make contact with the anatomy. These cuts would form a closely packedlattice array of pillars in the foam that stand on the intact base ofthe foam matrix.

The tightly packed lattice array of pillars of matrix are substantiallymade in the foam matrix on the patient contact side of the device. Thegrid-like distribution of pillars enables the patient or care giver theopportunity to decide where the customizing of the device is to occur.By picking and plucking away the pillars of matrix, it is easy to form adepression in the material that conforms to the anatomy of the patientsurface that is targeted for support and offloading. The remainingintact portions of the pillars work in consort with neighboring pillarsto act in a fashion similar to that expected of a solid matrix ofmaterial. In other word's there is not appreciable space between thepillars of matrix. This is particularly important for position of aregion of the anatomy. The contiguous nature of the customized shapeprovides the necessary support, positioning and weight redistribution toaid in the avoidance of the formation of pressure injuries in thepatient.

A variation of the theme is the formation of cushioning devices that aregenerally contoured by the foam cutting process to conform to thegeneral anatomical shape that is intended for support. For instance, adevice cut from polyurethane foam to form a flat bottom and sides buthas a contoured top surface that conforms to the contours of theanatomy. One such device is formed so that it conforms to the back ofthe head and the cervical area. Once this shape is achieved then theentire top area of the device is cut partially the way to the bottom ofthe matrix to form the lattice array of foam pillars. Such a device isthen more precisely modified to fit the patient by the selective removalof portions of the pillars of foam to form a depression that wouldspecifically conform to the head and neck area. If some part of thatanatomy require total offloading, then a significantly large part of thepillars in that specific region could be removed so that the devicemakes no contact with the anatomy in that specific anatomical region.

The utility of the invention was proven by making and testing severalprototypes. Some examples of these prototypes include:

EXAMPLE 1

A device that incorporates the features of the invention was developedby cutting a block of polyurethane foam into a block 9″×7″×1.5″ using acontinuous programmable foam block cutter. The cut foam block from thisprocess was then subjected to a secondary cutting operation that cutparallel cuts 0.5″ wide and 1.25″ deep across one surface of the foam.This process was repeated in a perpendicular direction to the first setof parallel cuts. The resulting appearance of one side of the foam was across hatching of pillars of foam 0.5″×0.5″ that extended into the foam1.25″. Since the pillars were not cut entirely through to the oppositeside of the foam the entire device remained intact. The other side ofthe foam was uniform without any evidence of cross hatching.

The utility of the device was demonstrated by customizing it to fit a 4″diameter soft ball. The soft ball was placed in the center of the deviceand a felt pen was used to outline the edge of the area to becustomized. The pillars within the marked area were then picked andplucked with the ones in the center being pinched off and removed attheir bases and the ones out towards the perimeter being sequentiallypinched off closer to the outer top surface. Once the customizing wascomplete a depression in the foam was created so that the soft ballwould nestle into the depression with substantially uniform contact withpillars of foam. This customizing required only a few minutes to carryout and did not require any special equipment or machinery to complete.

EXAMPLE 2

Essentially the same device was made as in example 1 except that thedensity of foam in this example was significantly lower than the firstexample. This created a softer support device that conformed to thedesired shape but it was not sufficiently soft that bottoming out didnot occur when it was tested.

EXAMPLE 3

This device was cut in the same form as that in the first example deviceexcepting that the size was approximately 12″×9″×3″ which was moreconducive for use on an adult patient.

EXAMPLE 4

Polyurethane foam was initially cut to form a shape with a contouredshape that would generally fit the contour of the neck and head regionof a patient. The contoured block was generally 9″×7″×1.5″ in size. Theanatomical contact side of the device had a series of cuts in a gridlike fashion that extended from the surface into the matrix to 0.5″ fromthe bottom (66% of the depth). The device was placed in use to supportand offload a baby's head by selectively removing portions of pillars inthe central region of the foam to form a depression that precisely fitthe head of the baby.

What is claimed is:
 1. A cushioning device for the contours of ananatomical region that is conformable for purposes of supporting theposition of the anatomical region by said device; by redistribution ofthe weight of the anatomical region by said device; by total offloadingof weight to sub-regions of the anatomy supported by said devicecomprising; a foam assembly wherein a lattice of cuts are in said deviceto a partial depth of the matrix to form an array of adjoining pillarsof matrix continuously joined to the intact base matrix wherebyindividual pillars of said device are manually adjusted to form aconforming depression in said device for the purpose of support,positioning, weight redistribution, offloading.
 2. A cushioning deviceaccording to claim 1, wherein the device matrix is composed ofpolyurethane foam, viscoelastic foam, polyvinyl foam, natural andsynthetic rubber.
 3. A cushioning device according to claim 1, whereinthe scoring of the lattice array is on the anatomical contact side ofthe device.
 4. A cushioning device according to claim 1, wherein thelattice array of the device is scored on one side of the matrix to formpillars to a partial depth of the matrix where in the depth of thescoring ranges from 51% to 99% of the full depth; more preferably 60% to95% of the depth; most preferably 65% to 90% of the depth of the device.5. A cushioning device according to claim 1, wherein the pillars have asurface dimension that ranges from 0.1 cm square to 100 cm square; morepreferably 0.5 cm square to 16 cm square; most preferably 1 cm square to2 cm square.
 6. A cushioning device according to claim 1, wherein thelattice array of the device is scored to a partial depth of the matrixby a mechanical process such as cutting.
 7. A cushioning deviceaccording to claim 1, wherein the lattice array of the device is scoredto a partial depth of the matrix by molding during the formation of thefoam.
 8. A cushioning device for the contours of an anatomical regionthat is conformable for purposes of supporting the position of the headand neck region of the anatomy by said device; by redistribution of theweight of the anatomical region by said device; by total offloading ofweight to sub-regions of the anatomy supported by said devicecomprising; a foam assembly wherein a lattice of cuts are in said deviceto a partial depth of the matrix to form an array of adjoining pillarsof matrix continuously joined to the intact base matrix wherebyindividual pillars of said device are manually adjusted to form aconforming depression in said device for the purpose of support,positioning, weight redistribution, offloading.
 9. A cushioning deviceaccording to claim 8, wherein the device matrix is composed ofpolyurethane foam, viscoelastic foam, polyvinyl foam, natural andsynthetic rubber.
 10. A cushioning device according to claim 8, whereinthe scoring of the lattice array is on the anatomical contact side ofthe device.
 11. A cushioning device according to claim 8, wherein thelattice array of the device is scored on one side of the matrix to formpillars to a partial depth of the matrix where in the depth of thescoring ranges from 51% to 99% of the full depth; more preferably 60% to95% of the depth; most preferably 65% to 90% of the depth of the device.12. A cushioning device according to claim 8, wherein the pillars have asurface dimension that ranges from 0.1 cm square to 100 cm square; morepreferably 0.5 cm square to 16 cm square; most preferably 1 cm square to2 cm square.
 13. A cushioning device according to claim 8, wherein thelattice array of the device is scored to a partial depth of the matrixby a mechanical process such as cutting.
 14. A cushioning deviceaccording to claim 8, wherein the lattice array of the device is scoredto a partial depth of the matrix by molding during the formation of thefoam.
 15. A cushioning device for the contours of an anatomical regionthat is conformable for purposes of supporting the position of thesacral and coccyx region of the anatomy by said device; byredistribution of the weight of the anatomical region by said device; bytotal offloading of weight to sub-regions of the anatomy supported bysaid device comprising; a foam assembly wherein a lattice of cuts are insaid device to a partial depth of the matrix to form an array ofadjoining pillars of matrix continuously joined to the intact basematrix whereby individual pillars of said device are manually adjustedto form a conforming depression in said device for the purpose ofsupport, positioning, weight redistribution, offloading.
 16. Acushioning device according to claim 15, wherein the device matrix iscomposed of polyurethane foam, viscoelastic foam, polyvinyl foam,natural and synthetic rubber.
 17. A cushioning device according to claim15, wherein the scoring of the lattice array is on the anatomicalcontact side of the device.
 18. A cushioning device according to claim15, wherein the lattice array of the device is scored on one side of thematrix to form pillars to a partial depth of the matrix where in thedepth of the scoring ranges from 51% to 99% of the full depth; morepreferably 60% to 95% of the depth; most preferably 65% to 90% of thedepth of the device.
 19. A cushioning device according to claim 15,wherein the pillars have a surface dimension that ranges from 0.1 cmsquare to 100 cm square; more preferably 0.5 cm square to 16 cm square;most preferably 1 cm square to 2 cm square.
 20. A cushioning deviceaccording to claim 15, wherein the lattice array of the device is scoredto a partial depth of the matrix by a mechanical process such ascutting.
 21. A cushioning device according to claim 15, wherein thelattice array of the device is scored to a partial depth of the matrixby molding during the formation of the foam.
 22. A cushioning device forthe contours of an anatomical region that is conformable for purposes ofsupporting the position of the scrotum region of the anatomy by saiddevice; by redistribution of the weight of the anatomical region by saiddevice; by total offloading of weight to sub-regions of the anatomysupported by said device comprising; a foam assembly wherein a latticeof cuts are in said device to a partial depth of the matrix to form anarray of adjoining pillars of matrix continuously joined to the intactbase matrix whereby individual pillars of said device are manuallyadjusted to form a conforming depression in said device for the purposeof support, positioning, weight redistribution, offloading.
 23. Acushioning device according to claim 22, wherein the device matrix iscomposed of polyurethane foam, viscoelastic foam, polyvinyl foam,natural and synthetic rubber.
 24. A cushioning device according to claim22, wherein the scoring of the lattice array is on the anatomicalcontact side of the device.
 25. A cushioning device according to claim22, wherein the lattice array of the device is scored on one side of thematrix to form pillars to a partial depth of the matrix where in the thedepth of the scoring ranges from 51% to 99% of the full depth; morepreferably 60% to 95% of the depth; most preferably 65% to 90% of thedepth of the device.
 26. A cushioning device according to claim 22,wherein the pillars have a surface dimension that ranges from 0.1 cmsquare to 100 cm square; more preferably 0.5 cm square to 16 cm square;most preferably 1 cm square to 2 cm square.
 27. A cushioning deviceaccording to claim 22, wherein the lattice array of the device is scoredto a partial depth of the matrix by a mechanical process such ascutting.
 28. A cushioning device according to claim 22, wherein thelattice array of the device is scored to a partial depth of the matrixby molding during the formation of the foam.
 29. A cushioning device forthe contours of an anatomical region that is conformable for purposes ofsupporting the position of the torso region of the anatomy by saiddevice; by redistribution of the weight of the anatomical region by saiddevice; by total offloading of weight to sub-regions of the anatomysupported by said device comprising; a foam assembly wherein a latticeof cuts are in said device to a partial depth of the matrix to form anarray of adjoining pillars of matrix continuously joined to the intactbase matrix whereby individual pillars of said device are manuallyadjusted to form a conforming depression in said device for the purposeof support, positioning, weight redistribution, offloading.
 30. Acushioning device according to claim 29, wherein the device matrix iscomposed of polyurethane foam, viscoelastic foam, polyvinyl foam,natural and synthetic rubber.
 31. A cushioning device according to claim29, wherein the scoring of the lattice array is on the anatomicalcontact side of the device.
 32. A cushioning device according to claim29, wherein the lattice array of the device is scored on one side of thematrix to form pillars to a partial depth of the matrix where in the thedepth of the scoring ranges from 51% to 99% of the full depth; morepreferably 60% to 95% of the depth; most preferably 65% to 90% of thedepth of the device.
 33. A cushioning device according to claim 29,wherein the pillars have a surface dimension that ranges from 0.1 cmsquare to 100 cm square; more preferably 0.5 cm square to 16 cm square;most preferably 1 cm square to 2 cm square.
 34. A cushioning deviceaccording to claim 29, wherein the lattice array of the device is scoredto a partial depth of the matrix by a mechanical process such ascutting.
 35. A cushioning device according to claim 29, wherein thelattice array of the device is scored to a partial depth of the matrixby molding during the formation of the foam.
 36. A cushioning device forthe contours of an anatomical region that is conformable for purposes ofsupporting the extremity regions of the anatomy such as hand, elbow,arm, foot, leg by said device; by redistribution of the weight of theanatomical region by said device; by total offloading of weight tosub-regions of the anatomy supported by said device comprising; a foamassembly wherein a lattice of cuts are in said device to a partial depthof the matrix to form an array of adjoining pillars of matrixcontinuously joined to the intact base matrix whereby individual pillarsof said device are manually adjusted to form a conforming depression insaid device for the purpose of support, positioning, weightredistribution, offloading.
 37. A cushioning device according to claim36, wherein the device matrix is composed of polyurethane foam,viscoelastic foam, polyvinyl foam, natural and synthetic rubber.
 38. Acushioning device according to claim 36, wherein the scoring of thelattice array is on the anatomical contact side of the device.
 39. Acushioning device according to claim 36, wherein the lattice array ofthe device is scored on one side of the matrix to form pillars to apartial depth of the matrix where in the the depth of the scoring rangesfrom 51% to 99% of the full depth; more preferably 60% to 95% of thedepth; most preferably 65% to 90% of the depth of the device.
 40. Acushioning device according to claim 36, wherein the pillars have asurface dimension that ranges from 0.1 cm square to 100 cm square; morepreferably 0.5 cm square to 16 cm square; most preferably 1 cm square to2 cm square.
 41. A cushioning device according to claim 36, wherein thelattice array of the device is scored to a partial depth of the matrixby a mechanical process such as cutting.
 42. A cushioning deviceaccording to claim 36, wherein the lattice array of the device is scoredto a partial depth of the matrix by molding during the formation of thefoam.